Mental health literacy in maintenance hemodialysis: a qualitative study on recognition, knowledge fragmentation, and stigma-related help-seeking barriers.

BACKGROUND

Psychological distress is highly prevalent among patients undergoing maintenance hemodialysis (MHD), yet qualitative evidence on their mental health literacy (MHL) remains scarce.

OBJECTIVE

To explore the actual level of mental health literacy, existing challenges, and needs for psychological services among patients on maintenance hemodialysis; to identify the constituent dimensions of mental health literacy in this population; and to provide qualitative evidence for developing a localized, specialized mental health literacy scale for this group and implementing targeted psychological interventions.

METHODS

Using purposive sampling, semi-structured in-depth interviews were conducted with MHD patients meeting the inclusion criteria at the Hemodialysis Center of a Grade III-A hospital in Ningxia from December 2023 to February 2024. The principle of maximum diversity was applied to ensure sample diversity, and the number of interviews was determined based on data saturation; a total of 11 patients were interviewed. Data were managed using NVivo 14.0 software and analyzed using Braun and Clarke's thematic analysis method.

RESULTS

A total of 3 core themes and 6 subthemes were identified. Theme 1: Heterogeneity Recognizing of Mental Illness. Theme 2: Fragmented Mental Health Knowledge. This includes: 2a Polarized Approaches to Health Information; 2b Superficial Attribution Patterns; 2c Polarization of Self-Regulation Strategies; 2d Uneven Awareness of Mental Health Resources. Theme 3: Ambivalent attitudes toward mental illness and seeking help. This includes: 3a Cognitive Attitudes: Coexistence of Stigma and Normalization; 3b Behavioral Attitudes: The Gap between Intention and Action.

CONCLUSION

MHL among MHD patients is characterized by insufficient illness recognition, fragmented knowledge, and pronounced stigma-related help-seeking barriers. Targeted, tiered psychoeducation and a culturally adapted MHL assessment tool are urgently needed for this population.